One form of acid reflux remedy that you are probably already aware of, but may not understand fully how they work are acid suppressant drugs. These drugs act on the acid-producing mechanisms within the stomach wall, so that they greatly reduce the amount of acid inside the stomach. This is a more effective acid reflux relief as it eases the symptoms for most people with moderate to severe esophagitis than antacid combinations.

Cimetidine (Tagamet) was the first of this group of acid reflux remedies. It revolutionized the treatment of gastric and duodenal ulcers, but it was marginally less successful when tried against reflux esophagitis. Patients taking it in the early trials found that their symptoms were much less, but endoscopy appearances showed that they still had a moderate degree of inflammation in the esophagus.

The early doses were possibly too low, and many people with acid reflux disease have to take double the original dose of 400 mg to keep their symptoms at bay.

Ranitidine (Zantac) is another H2 receptor antagonist. It is similar in effect to cimetidine, and the usual dose is 300 mg each evening. The dose can be raised up to as much as 1500 mg daily for added benefit, although most doctors would prefer not to go so high, and use another acid reflux treatment, probably a proton pump inhibitor, instead.

Newer H2 antagonists include famotidine (Pepcid) and nizatidine (Axid). They are similar in action to cimetidine and ranitidine, with little to choose between them.

All drugs, including these GERD and acid reflux remedies, may produce side-effects, and acid-suppressant drugs are no exception. H2 receptor antagonists should be used with caution in people with liver or kidney problems or who are pregnant or breast feeding. They may ‘mask’ the symptoms of stomach cancer, so if you have one or more of the ‘alarm’ symptoms your specialist will rule out stomach cancer before prescribing one.

Side-effects of this group of drugs are relatively rare, but they include diarrhea, headache, dizziness, rash and tiredness. Much rarer are effects on the heart rhythm, on the bone marrow and occasional reports of enlarged breasts in men (gynaecomastia) and impotence.

Cimetidine has a disadvantage compared with other drugs in this group, in that it interacts with drugs that use the same type of mechanism in the liver for their breakdown. So it cannot be taken alongside warfarin (an anti-clotting drug), phenytoin (for epilepsy) or theophylline (for asthma).

The other drugs in this group may be taken instead.

Proton pump inhibitors

Proton pump inhibitors (PPIs) act on the acid-producing mechanism at an earlier stage in the process than H2 antagonists, so that they completely eradicate acid, rather than reduce it, from the stomach contents.

The first PPI was omeprazole (Losec). It has since been joined by esomeprazole (Nexium), lansoprazole (Zoton), pantoprazole (Protium) and rabeprazole (Panel).

As with the H2 antagonists, PPIs are so efficient in removing symptoms in reflux disease, even when it is severe, that they can ‘mask’ a stomach cancer. When a person shows ‘alarm features’ the specialist team must rule out a stomach or esophageal cancer before prescribing them.

Side-effects of PPIs are similar to those of the H2 antagonists. The patient leaflet for PPIs list alt the side-effects that have been reported: they look horrendous, but it must be remembered that they are all very rare. Most people find these acid reflux remedies easy to tolerate and that they have no side-effects. However, it is important to read the leaflet, so that if a problem does arise, you can tell what it is, and deal with it accordingly.